Health care experts doubt changes to GOP bill with lead to more coverage

iStock/Thinkstock(WASHINGTON) — Health care experts doubt that the amendments added Monday night to the Republican health care bill will change top-line numbers estimates from the Congressional Budget Office about how many people will be uninsured under the proposed bill or how much out of pocket cost may go up.

“The notion that the basic story is going to be fundamentally different is probably not true — the bill is basically what the bill is,” Dr. Michael Chernew, director of the Healthcare Markets and Regulation Lab at Harvard Medical School, told ABC News.

Karen Pollitz of the non-profit Kaiser Family Foundation said the changes were mostly done to appease political concerns.

“In the plain language of the law, there is not a lot in this manager’s amendment that would change things substantially for real Americans,” she says. “There is this question mark –- a change in a provision that might increase somewhat the tax credits for older people. But it’s not spelled out. There’s just a lot of buzz about it.”

One of the other major concerns with the bill were skyrocketing, out-of-pocket costs projected for lower income, older Americans, who could see costs rise but their tax credit shrink significantly compared to current subsidies provided under current law.

The changes to the House bill do not directly address this. Instead, Republicans tweaked another part of the bill dealing with tax deductions to essentially bring in a little more cash for the government without raising the cost of the bill. They are telling moderate members that the Senate can use the new bundle of money to bump up the tax credits to seniors.

(House Republicans changed how much people would be able to deduct on their taxes for medical expenses from 10 percent currently to 5.8 percent. It was 7.5 percent in the older version of the bill. Staff hopes that results in approximately $85 billion for the Senate to allocate.)

Matt Fiedler, a fellow at the Center for Health Policy at Brookings Institution, was skeptical that that money would really be able to change the overall coverage.

“Where are the coverage losses in the bill coming from? They are coming from the Medicaid provisions, the repeal of the individual mandate and the change in the credit structure,” he said. “Changing the credit structure does not do anything about the first two buckets,” he said, adding that the bill currently spends about $300 billion less on tax credits than current subsidies.

“Even if they use that $85 billion in an optimal way to sort of fill in the gaps they have created … they are filling in less than a third of one prong of the problem,” Fiedler added.

Fiedler said some of the changes to the bill could help expand coverage, but that others would likely cut coverage too.

For instance, the Rules Committee on Monday night passed a provision changing how interest rates are calculated for Medicaid, which in turn, experts say, could help relax some of the caps for that states hit with their Medicaid spending. Bottom line, this small change could lead to more coverage, by giving states more flexibility to keep people on their Medicaid rolls.

On the flip-side, the package of changes added last night also give states license in to change their Medicaid programs in ways that would likely lead to fewer people being covered.

The bill now expressly allows states to require “able-bodied” adults on Medicaid to show proof of work to get coverage. Dr. Richard Frank, former deputy assistant secretary for planning and evaluation at HHS under Obama, told ABC News that he thought work requirements would largely impact the mentally-ill people or those struggling with addiction.

“If you take away their coverage because of that, you are going to reduce their chance of working rather than if you cover them and get them treatment,” he said.

The bill also now allows states to receive Medicaid funding as one big block grant from the federal government, not on a per capita basis, a change that many experts argue would lead to fewer people being enrolled.

“My is take if I was a Medicaid advocate, I don’t think this goes very far if at all to making me feel very comfortable,” Chernew said. “If I were a senator I would be concerned about the exact same things I was concerned about before the manger’s amendment, which is they’re taking a fair bit out of the health care system, largely out of Medicaid.”